Reactive Erythema Research Articles

Drug-Induced Erythema Annulare Centrifugum after Dupilumab Therapy: A Case Report.

Introduction: Dupilumab is a fully human monoclonal antibody therapy FDA-approved to treat moderate-to-severe atopic dermatitis (AD) by interrupting the pro-inflammatory signaling pathway of interleukins 4 and 13. Common side effects of dupilumab include injection-site reactions, ophthalmic complications, and upper respiratory infections. We discuss the necessity for early recognition and management of dupilumab-induced EAC which has not been previously reported as a potential adverse effect.
 Case Report: A 48-year-old woman began treatment with dupilumab for severe AD and subsequently presented with a 3-month history of erythematous annular plaques with trailing scale on the trunk and extremities. She failed treatment with topical corticosteroids as well as topical and oral antifungals prior to being diagnosed with biopsy-confirmed erythema annulare centrifugum (EAC). The condition worsened after replacing dupilumab with tralokinumab but resolved after discontinuation of the drugs and has remained clear since.
 Conclusion: EAC is a reactive erythema that typically presents as expanding annular papules and plaques with central clearing and in some cases, trailing scale at the rim of the lesions. There are currently no reports in the literature describing the development of EAC secondary to dupilumab. Clinicians should be aware that EAC may be a potential adverse effect of dupilumab.

Skin Manifestations Among Patients Admitted with COVID-19: A Cross-Sectional Study at a University-Based Tertiary Hospital in Jordan.

COVID-19 pandemic hit the entire world with severe health and economic consequences. Although the infection primarily affected the respiratory system, it was soon recognized that COVID-19 has a multi-systemic component with various manifestations including cutaneous involvement. The main objective of this study is to assess the incidence and patterns of cutaneous manifestations among moderate-to-severe COVID-19 patients who required hospitalization and whether there was a prognostic indication for cutaneous involvement and the outcome in terms of recovery or death. This is a cross-sectional observational study that included inpatients who were diagnosed with a moderate or severe COVID-19 infection. The demographic and clinical data of patients were assessed including age, sex, smoking, and comorbidities. All patients were examined clinically for the presence of skin manifestations. Patients were followed for the outcome of COVID-19 infection. A total of 821 patients (356 females and 465 males) aged 4-95 years were included. More than half of patients (54.6%) aged >60 years. A total of 678 patients (82.6%) had at least one comorbid condition, mostly hypertension and diabetes mellitus. Sixty-two patients (7.55%) developed rashes; 5.24% cutaneous and 2.31% oral. The rashes were then grouped into five major types: group A, Exanthema: morbilliform, papulovesicular, varicella-like. Group B, Vascular: Chilblain-like lesions, purpuric/petechial, livedoid lesions. Group C, Reactive erythemas: Urticaria, Erythema multiforme. Group D, other skin rashes including flare-up of pre-existing disease, and O for oral involvement. Most patients (70%) developed rash after admission. The most frequent skin rashes were reactive erythema (23.3%), followed by vascular (20.9%), exanthema (16.3%), and other rashes with flare-ups of pre-existing diseases (39.5%). Smoking and loss of taste were associated with the appearance of various skin rashes. However, no prognostic implications were found between cutaneous manifestations and outcome. COVID-19 infection may present with various skin manifestations including worsening of pre-existing skin diseases.

Retracted] CT and MRI Imaging Characteristics of Gastrointestinal and Mesangial Reactive Nodular Fibrous Pseudotumor Based on Virtual Reality

In recent years, with the continued development and development of science and technology and the increasing maturity of medical technology, reactive nodular fibrous pseudotumors remain difficult to diagnose. Therefore, this paper studies CT and MRI imaging properties based on hypothetical gastrointestinal and mesangial reactive erythema nodosum fibrous pseudotumors to improve the diagnosis and treatment of reactive nodular fibrous pseudotumors. In this study, 48 patients with gastrointestinal and intermediate‐reactive erythema nodosum fibrous pseudotumors in the gastrointestinal tract and experimental group were screened and identified by surgical pathology and immunohistochemistry. CT or magnetic resonance imaging was used in all patients. An analysis is performed, and the diagnostic values are compared with the pathological results. Experiments have proved that the postoperative reexamination of reactive nodular fibrous pseudotumors found that single masses are common, tumor sizes are different, and most small nodules have relatively more uniform lesion density, and the density of the plain scan is close to the muscle density, and the delay can be seen after enhancement. When the mass is large, the density is uniform, and low‐density foci of different degrees can be seen in some masses, and this part rarely shows enhancement. The imaging phenomenon and clinical features of reactive nodular fibrous pseudotumors have specific features that distinguish them from invasive tumors such as gastrointestinal stromal tumors and provide an important basis for accurate clinical diagnosis and treatment.

Eritema multiforme reaccional como manifestación atípica de lepra. Reporte de caso

Eritema multiforme reaccional como manifestación atípica de lepra. Reporte de caso

Paraneoplastic erythema annulare centrifugum eruption (PEACE)

Erythema annulare centrifugum (EAC) is a reactive erythema with distinct, annular, erythematous plaques with trailing scale. This condition has been associated with various etiologies, which include an associated malignant condition. EAC with cancers or paraneoplastic erythema annulare centrifugum eruptions (PEACE), is more likely to be associated with lymphoproliferative malignancies such as lymphomas and leukemias. Histopathologic features include a superficial and deep, lymphohistiocytic perivascular infiltrate. We present a patient with a history of diffuse large B cell lymphoma in remission for two years, who presented with a one-year history of EAC.

Combined Reduced-Antigen Content Tetanus, Diphtheria, and Acellular Pertussis (Tdap) Vaccine-Related Erythema Nodosum: Case Report and Review of Vaccine-Associated Erythema Nodosum

BackgroundVaccination programs reduce the morbidity and mortality of diphtheria, pertussis, and tetanus. Erythema nodosum is a reactive erythema that can be associated with infections, drugs, and many conditions. The new onset of erythema nodosum after receiving vaccination is uncommon.PurposeCombined reduced-antigen content tetanus, diphtheria, and acellular pertussis (Tdap) vaccine-associated erythema nodosum is described and the reports of vaccine-related erythema nodosum are summarized.MethodsThe clinical features of a 39-year-old woman who developed erythema nodosum after receiving Tdap vaccine are reported. Using the PubMed database, an extensive literature search was performed on erythema nodosum, vaccine, and vaccination.ResultsTdap, the most commonly used booster vaccine against tetanus, diphtheria, and pertussis, is well tolerated in all age groups. Local injection-site reactions are the most common adverse events, whereas headache, fatigue, gastrointestinal symptoms, and fever are the most frequent systemic events. Erythema nodosum has not previously been reported in patients who have received Tdap vaccine. The patient developed erythema nodosum within 48 h after receiving Tdap vaccine; her symptoms cleared and nearly all skin lesions resolved within 2 weeks after initiating oral treatment with ibuprofen, fexofenadine, and prednisone. Vaccine-associated erythema nodosum has previously been reported following vaccination for cholera, hepatitis B, human papillomavirus, malaria, rabies, small pox, tuberculosis, and typhoid.ConclusionVaccine-associated erythema nodosum is uncommon. Erythema nodosum occurring after Tdap vaccination is a rare, yet potential, adverse effect.

Paraneoplastic Erythema Annulare Centrifugum Eruption: PEACE

Erythema annulare centrifugum is a reactive erythema of various possible etiologies including, although less often, an associated cancer. Cancer-related erythema annulare centrifugum is most commonly associated with lymphoproliferative malignancies, specifically lymphoma and leukemia. Malignancy-associated erythema annulare centrifugum is more frequently seen in women than men and the presence of skin lesions usually precedes the clinical diagnosis of the underlying malignancy. Neoplasm-derived erythema annulare centrifugum lesions often resolve following treatment of the cancer. Recurrence of erythema annulare centrifugum may occur along with the relapse of the underlying malignancy. Paraneoplastic erythema annulare centrifugum eruption (PEACE) is speculated to be a result of a cytokine or other tumor-associated factors.

Delineating Capillary Malformations in the Operating Suite Using White Eyeliner Pencil

Delineating the extent of capillary malformations in the operating suite can be challenging because of a variety of physiologic modifiers, including vasodilatation induced by anesthesia, reactive erythema, and filtering of colors with protective laser eyewear. The use of traditional surgical pens to mark the treatment field has limitations; we have found the use of a white eyeliner pencil to delineate lesions a contemporary technique that assists in identifying the target tissue intraoperatively.

A reply

The appearance of transitory erythema following local heating is a not uncommon biological response that has interested physiologists for nearly 100 years [1]. Dr Siddik-Sayyid and colleagues characterised the response they observed as a thermal burn of first degree; however, the conditions and observations enumerated in their report argue against the classification. While blanching erythema is a necessary sign of a first-degree burn, symptoms of inflammation, including pain, itching, or swelling are also required to confirm the diagnosis. In the absence of a histopathological analysis, the reported lack of pain, itching, induration, and the transitory nature of the response all suggest a reactive erythema, not a burn. Although many forced-air warming devices are designed to produce elevated local convective heat transfer coefficients, the maximum inlet temperature is usually limited to 43 °C, or lower, to prevent thermal damage to the underlying tissue. As noted by the authors of the report, the mean temperatures beneath the blanket were between 34.9 and 36.1 °C, which are well below the thermal injury threshold of 43 °C for intact human skin [2, 3]. On rare occasions and in certain susceptible people, rapid increases in the temperature of tissue nociceptors can produce dramatic local increases in tissue perfusion that may persist for several hours [4]. This responsive increase in blood flow is not an injury or a nascent burn because there is no associated short- or long-term tissue damage. In this case, a fluid warmer was also used; however, it is important to note the principle that the effect of multiple heat sources is not additive with respect to temperature. Although the set-point temperature of the fluid warmer indicated 41 °C, the actual infusate temperature at the venous access site is generally at or below the blood temperature. Thus, the concomitant use of fluid warming does not influence the skin response or the risk of cutaneous injury. There are also other possible explanations for the erythema. There have been reports of cutaneous responses that are probably reactions to some compounds contained in certain surgical scrubs or surgical prewash solutions, especially ones that contain agents like chlorhexidine gluconate or sodium lauryl sulfate [5]. These reactions are apparently accentuated by heat and mild sweating. While it may be technically correct to refer to these responses as ‘injuries’, the responses were self-limited and resolved rapidly without additional medical intervention.

A Case of Toxic Epidermal Necrolysis

Toxic epidermal necrolysis is a reactive erythema of nonstaphylococcal origin characterized by a scalded appearance of the skin. The TEN is widely regarded as a variant of severe erythema multiforme because of its acute course, its freguent common cause, its freguent overlap with Stevens-Johnson disease, and its histologic identity. I present a case of TEN with severe mucosal involvement resembled Stevens-Johnson disease.